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Attention Deficit Hyperactivity Disorder (ADHD)

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Introduction

Here you’ll find answers to some of the questions that parents often have about this condition. Additional resources are listed at the bottom of the page. Diagnosis and management information can be found in the Attention Deficit Hyperactivity Disorder (ADHD) module, which is written for primary care clinicians but also may be of help to parents and family members.

What is ADHD and what causes it?

ADHD is a chronic disorder that begins in childhood (ages 4-18) and is characterized by some combination of hyperactivity, impulsivity, and/or inattention. Although ADHD clearly runs in families, and twin and adoption studies support a strong genetic component, the genetic mechanisms are not yet well understood. Environmental factors are also shown to play a role in some cases. Many other things can cause ADHD-like symptoms, such as stress, lack of sleep, medication side effects, and other medical problems.

What are the symptoms of ADHD?

Toddlers with the hyperactive/impulsive type may be constantly physically active, running in circles, and climbing on furniture, whereas adolescents with this type may engage in risky behaviors and sports. Preschoolers with the inattentive type may have difficulty attending to the reading of a picture book, whereas adolescents may have difficulty finishing homework and performing required tasks. Many children with ADHD will be able to concentrate on their favorite activities for prolonged periods, such as playing hours of video games, but have a hard time concentrating on tasks they need to do, such as homework.

How is it diagnosed?

Most children with ADHD are diagnosed and managed within the medical home. Guidelines for diagnosis have been published by the American Academy of Pediatrics (AAP), which can be found at [Wolraich: 2011]. The guidelines focus on children with normal IQ and without chronic problems such as sensory deficits, a history of severe psychosocial problems, and/or features of autism, all of which can complicate the diagnostic process. Evaluation for ADHD should be initiated if the child presents with problematic levels of inattention, hyperactivity, or impulsivity, low school achievement for the child's IQ, and/or behavior problems. The evaluation will generally take a few visits and will require gathering information regarding school performance, school/daycare behavior, functioning within the family and with friends, and other medical or mental health concerns.

What is the prognosis?

ADHD is considered a life-long condition. However, children can learn skills to help manage their symptoms and play to their strengths. Not all children or adults will need medication to manage ADHD.

What is the risk for other family members or future babies?

ADHD tends to run in families; the parents and the primary care clinician should be alert to this possibility in siblings.

What treatments/therapies/medications are recommended or available?

Stimulant medications for children with ADHD are currently considered the most effective treatment for ADHD symptoms. Behavior therapy (also called behavior modification or psychosocial treatment) is the most effective non-medication therapy for children. Behavior therapy is generally directed at parents and teachers to improve structure and communication.

How will my child and our family be impacted?

Parents of children with ADHD report significant impact on parent emotional health and family functioning. [Klassen: 2004] Children with ADHD are more likely to have difficulty with social interactions with peers and participating in group activities. They may also have a harder time learning to take care of themselves, needing frequent reminders and supports. Children with ADHD are more likely to have conduct disorder and substance abuse as teenagers, especially if untreated or undertreated as children. [Klassen: 2004] [Wilens: 2008] [Pliszka: 2007] [Klassen: 2004] Effective management of ADHD can really improve quality of life for the child and his or her family and community.

I don't want to get my child addicted to drugs by starting them on stimulants.

Not only do children with ADHD not get addicted to (or dependent upon) stimulants, some evidence suggests that judicious use of stimulants in the early years decreases risk of adolescent cigarette smoking and drug use. The exact reasons are not understood, but reduced self-esteem due to school problems and the impulsivity that accompanies ADHD may contribute to drug use among children who are not treated for their ADHD. [Wilens: 2008] Another study suggests that stimulant use for ADHD does not either increase or decrease later illicit substance abuse. [Shaw: 2012]

I have heard that stimulants are associated with heart problems. Is there another safer remedy such as a diet that will help my child?

Behavioral therapy is an important part of the management of ADHD, but for many children is not enough to manage their symptoms. The risk of heart problems with stimulants, which are the most common class of medication used to treat ADHD, is very small. The current American Academy of Pediatrics guidelines for treatment of ADHD does not clearly demonstrate an increased risk of serious cardiovascular events in children using stimulant medication. The medical home provider should discuss specific concerns based on your child and family’s health history.

How long will my child need to be on medication?

ADHD medications do not cure ADHD; they help manage the symptoms of ADHD. The manifestations of ADHD will improve over time in most patients, but some will continue to benefit from medication even in adulthood. So, the length of treatment will depend on the child and whether he/she associated learning problems. Your primary care clinician will monitor progress at regular intervals to determine with you and your child when to consider stopping medication.

I've heard about medication holidays. What does that mean?

You, your child, and your primary care clinician can discuss if there are times that stimulants are not needed (such as prolonged school holidays or even weekends). This would not apply to children on atomoxetine (Strattera) or extended-release preparations of guanfacine and clonidine.

What are side effects of stimulant medications?

Common side effects include decreased appetite, insomnia, anxiety or nervousness, stomachache or headache, increased heart rate and blood pressure, and irritability (most often as the medication wears off in the afternoon/evening). Often increasing the dose slowly over time can avoid many of these side effects. Adding a small dose in the afternoon can sometimes eliminate irritability. Since one stimulant may work better than another for your child, try a different kind before giving up.

Will my child be shorter if he takes stimulants?

While stimulants can lead to weight loss in some children, it appears that use of stimulants does not prevent children from growing to their full adult height. [Harstad: 2014]
Your primary care clinician will track weight and height before, during, and after stimulant use to identify any concerns about growth while your child is growing.

Why doesn’t my insurance cover behavior therapy for ADHD?

Many insurers cover stimulant medications for children with ADHD because these are currently considered the most effective treatment for ADHD symptoms. Insurers may cover behavior therapy for comorbid conditions such as depression, substance abuse, or anger management. Some behavioral approaches can be provided through the public school system, such as social skills training, depending on the availability of skilled staff and the needs of the child.

Resources

Information & Support

Where can I go for further information?

Books for Children:
  • Otto Learns about His Medicine: A Story About Medication for Children With ADHD [Galvin: 2001]
  • Being in Control: Natural Techniques for Increasing Your Potential and Creativity for Success in School [Alster: 2001]
  • Eagle Eyes: A Child's Guide to Paying Attention (The Coping Series) [Gehret: 2009]
  • Jumpin' Johnny Get Back to Work: A Child's Guide to Adhd-Hyperactivity [Gordon: 1993]
  • Shelley, the Hyperactive Turtle [Moss: 1989]
  • Learning to Slow Down and Pay Attention [Nadeau: 2004]
  • Putting on the Brakes: Understanding and Taking Control of Your ADD or ADHD [Quinn: 2009]
  • Cory Stories: A Kid’s Book About Living with ADHD [Kraus: 2004]
  • The Adventures of Phoebe Flower: Stories of a Girl with ADHD [Roberts: 2010]
  • The Survival Guide for Kids with ADHD [Taylor: 2012]
Although the books aren’t about ADHD, the popular young adult Percy Jackson series by Rick Riordan features young heroes who all have ADHD. [Riordan: 2014]

Books for Parents:
  • Smart but Scattered [Dawson: 2009]
  • ADHD: What Every Parent Needs to Know (2nd ed.) [Reiff: 2011]
  • Taking Charge of ADHD (3rd ed.) [Barkley: 2013]
  • You and Your A.D.D. Child: How to Understand and Help Kids With Attention Deficit Disorder [Warren: 1995]
See Books for Adults, Teens, Children: NRC Staff Favorites (National Resource Center on ADHD) for more titles.

For Parents and Patients

Support

Children and Adults with ADHD (CHADD)
A national non-profit organization, with numerous local chapters, that provides education, advocacy, and support for individuals with ADHD; Children and Adults with Attention Deficit/Hyperactivity Disorder.

Understood for Learning & Attention Issues
A collaboration between 15 non-profit agencies to provide resources to parents of children with learning and attention disorders.

General

ADHD (MedlinePlus)
Provides links to high-quality sources of information about ADHD; a service of the National Library of Medicine and National Institutes of Health.

What is ADHD? (KidsHealth)
Health information for parents, kids, and teens. This is the parent's page on ADHD, see the tabs at the top for the pages focused on kids and teens; sponsored by Nemours Foundation.

The Diet Factor in ADHD (AAP)
A comprehensive overview of the role of dietary methods for treatment of children with ADHD when pharmacotherapy has proven unsatisfactory or unacceptable; American Academy of Pediatrics.

ADHD Information (AAP)
List of publications for parents of children with ADHD; American Academy of Pediatrics.

Patient Education

ADHD Information (NIMH)
Overview and links to more information from the National Institute of Mental Health

ADHD: Parents' Medication Guide (PDF Document 1.1 MB)
Forty-five page booklet that helps youngsters and their families better understand the treatments for ADHD; prepared by the American Academy of Child & Adolescent Psychiatry and American Psychiatric Association (2013).

Services

Clinical Social Worker (LCSW) (MSW)

See all Clinical Social Worker (LCSW) (MSW) services providers (225) in our database.

Developmental - Behavioral Pediatrics

See all Developmental - Behavioral Pediatrics services providers (5) in our database.

Developmental Pediatrics

See all Developmental Pediatrics services providers (4) in our database.

Family Counseling Agencies

See all Family Counseling Agencies services providers (39) in our database.

Marriage & Family Therapist (LMFT, LFT)

See all Marriage & Family Therapist (LMFT, LFT) services providers (45) in our database.

Mental Health Counselor (LPC, LCPC, CMHC)

See all Mental Health Counselor (LPC, LCPC, CMHC) services providers (80) in our database.

Neuropsychiatry/Neuropsychology

See all Neuropsychiatry/Neuropsychology services providers (18) in our database.

Outpatient Community Mental Health Agencies

See all Outpatient Community Mental Health Agencies services providers (148) in our database.

Outpatient Private Therapy Practices

See all Outpatient Private Therapy Practices services providers (343) in our database.

Pediatric Cardiology

See all Pediatric Cardiology services providers (3) in our database.

Pediatric Neurology

See all Pediatric Neurology services providers (4) in our database.

Psychiatrist, Child-18 (MD)

See all Psychiatrist, Child-18 (MD) services providers (22) in our database.

Psychologist, Child-18 (PhD, PsyD)

See all Psychologist, Child-18 (PhD, PsyD) services providers (143) in our database.

School Districts

See all School Districts services providers (52) in our database.

For other services related to this condition, browse our Services categories or search our database.

Studies

Clinical Trials in ADHD (clinicaltrials.gov)
Trial listings for ADHD with "completed," "recruiting," and "active" status noted.

Mental Health Clinical Trials (NIMH)
Links to descriptions of clinical trials related to numerous mental health conditions, including ADHD, anxiety, and depression; National Institute of Mental Health.

Authors & Reviewers

Initial Publication: March 2012; Last Update: April 2015
Current Authors and Reviewers (click on name for bio):
Author: Lynne M. Kerr, MD, PhD
Reviewers: Jennifer Goldman-Luthy, MD, MRP, FAAP
Robyn Nolan, MD
Funding: The Medical Home Portal thanks the 2011-2012 URLEND Medical Home Portal trainees group for their contribution to this page.
Authoring history
(Limited detail is available on authoring dates before 2014.)
AAuthor; CAContributing Author; SASenior Author; RReviewer

Page Bibliography

Alster JM.
Being in Control: Natural Techniques for Increasing Your Potential and Creativity for Success in School (Paperback).
Rainbow Cloud; 2001. 9659025114

Barkley R.
Taking Charge of ADHD .
Third Edition ed. The Guilford Press; 2013. 978-1462507894 http://www.amazon.com/Taking-Charge-ADHD-Third-Authoritative/dp/146250...

Dawson P.
Smart but scattered.
Guilford Press; 2009. 978-1593854454 http://www.amazon.com/Smart-but-Scattered-Revolutionary-Executive/dp/1...

Galvin M.
Otto Learns About His Medicine: A Story About Medication for Children With ADHD.
3rd ed. Washington DC: Magination Press; 2001. 1557987726 http://www.apa.org/pubs/magination/4417726.aspx
Otto, a fidgety young car, has trouble paying attention in school, has trouble remembering important information, and is unable to listen long enough to learn how to drive. Otto and his parents visit a special mechanic who explains about "car medicine" that can help him control his behavior. This delightful story addresses the concerns felt by children who have been prescribed drugs to reduce hyperactive behavior.

Gehret Jeanne, LaDuca Michael.
Eagle Eyes: A Child's Guide to Paying Attention (The Coping Series) (Hardcover).
Revised ed. Verbal Images Press; 2009.

Gordon M.
Jumpin' Johnny Get Back to Work: A Child's Guide to Adhd-Hyperactivity (Paperback).
Gsi Publications; 1993. 9780962770142

Harstad EB, Weaver AL, Katusic SK, Colligan RC, Kumar S, Chan E, Voigt RG, Barbaresi WJ.
ADHD, stimulant treatment, and growth: a longitudinal study.
Pediatrics. 2014;134(4):e935-44. PubMed abstract / Full Text

Klassen AF, Miller A, Fine S.
Health-related quality of life in children and adolescents who have a diagnosis of attention-deficit/hyperactivity disorder.
Pediatrics. 2004;114(5):e541-7. PubMed abstract

Kraus J.
Cory stories: a kid's book about living with Adhd.
Magination Press; 2004. 978-1591471547 http://www.amazon.com/Cory-Stories-Kids-About-Living/dp/1591471540

Moss DM.
Shelley, the Hyperactive Turtle (Special Needs Collection) (Hardcover).
Woodbine House; 1989. 9780933149311

Nadeau K.
Learning to Slow Down and Pay Attention.
3rd ed. Magination Press; 2004. 978-1591471554 http://www.amazon.com/Learning-Slow-Down-Pay-Attention/dp/1591471559

Pliszka S.
Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder.
J Am Acad Child Adolesc Psychiatry. 2007;46(7):894-921. PubMed abstract
Historical ADHD guideline from 2007.

Quinn PO, Stern JM, Lee J.
Putting on the Brakes: Understanding and Taking Control of Your ADD or ADHD.
2nd Edition ed. Magination Press; 2009. 978-1-4338-0441-0

Reiff M.
ADHD: What Every Parent Needs to Know .
2nd ed. American Academy of Pediatrics; 2011. 978-1581104516 http://www.amazon.com/ADHD-What-Every-Parent-Needs/dp/1581104510

Riordan R.
Percy jackson and the olympians.
Disney-Hyperion; 2014. 978-1484707234 http://www.amazon.com/Jackson-Olympians-Paperback-covers-poster/dp/148...

Roberts B.
The adventures of phoebe flower: stories of a girl with Adhd.
Advantage Books; 2010. 978-0971460966 http://www.amazon.com/Adventures-Phoebe-Flower-Stories-Girl/dp/0971460...

Shaw M, Hodgkins P, Caci H, Young S, Kahle J, Woods AG, Arnold LE.
A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment.
BMC Med. 2012;10:99. PubMed abstract / Full Text

Taylor J.
Survival guide for kids with Adhd .
ReadHowYouWant; 2012. 978-1442996823 http://www.amazon.com/The-Survival-Guide-Kids-ADHD/dp/144299682X

Warren P, Capeheart J.
You and Your A.D.D. Child: How to Understand and Help Kids With Attention Deficit Disorder (Paperback).
Nelson Books; 1995. 0785278958

Wilens TE, Adamson J, Monuteaux MC, Faraone SV, Schillinger M, Westerberg D, Biederman J.
Effect of prior stimulant treatment for attention-deficit/hyperactivity disorder on subsequent risk for cigarette smoking and alcohol and drug use disorders in adolescents.
Arch Pediatr Adolesc Med. 2008;162(10):916-21. PubMed abstract / Full Text

Wolraich M, Brown L, Brown RT, DuPaul G, Earls M, Feldman HM, Ganiats TG, Kaplanek B, Meyer B, Perrin J, Pierce K, Reiff M, Stein MT, Visser S.
ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.
Pediatrics. 2011;128(5):1007-22. PubMed abstract / Full Text